Mortality Risk Heightened With Early Recurrence of Hepatic Encephalopathy After TIPS

In patients with cirrhosis who underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure, there is a greater risk of mortality linked with early recurrence of overt hepatic encephalopathy (OHE).

To investigate, the researchers retrospectively examined a total of 304 consecutive patients with cirrhosis and a TIPS performed from January 2012 to December 2013 at a single institution. There were 196 male patients, patients’ mean age was 52 years, and patients’ mean Model for End-Stage Liver Disease (MELD) score was 11.6. To estimate the predictive ability of early OHE and how its frequency influences survival, time-dependent Cox regression was used.

Patients were followed up for a median of 28.3 months, during which 115 had OHE after the TIPS procedure, with 54 patients having at least 2 instances of OHE. Analysis showed worse outcomes for survival in individuals who had early OHE ((hazard ratio [HR] = 2.75), which was defined as occurring within 3 months after TIPS.

After further categorizing early OHE into early-recurrent and single OHE, researchers found that more patients with early-recurrent OHE died than patients with early-single OHE. Adjustment by MELD score, ascites, serum albumin, indication for TIPS, and age yielded data showing that patients with early-recurrent OHE had a lower probability of survival. The predictive value of early-recurrent OHE was confirmed by landmark and propensity score analyses.

“The current study showed that secondary OHE episodes occurred mostly within 3 months, and that approximately 44% of patients who had a first OHE episode after a TIPS would experience recurrent OHE within 3 months,” the researchers stated. “For these high-risk patients, intensive surveillance and prophylaxis should be considered during this dangerous period.”

They added that prospective studies are needed to ascertain whether pharmacologic interventions can prevent OHE recurrence after the TIPS procedure.

—Lauren LeBano

Reference

Zuo L, Iv Y, Wang Q, et al. Early-recurrent overt hepatic encephalopathy is associated with reduced survival in cirrhotic patients after transjugular intrahepatic portosystemic shunt creation. J Vasc Intervent Radiol. doi:https://doi.org/10.1016/j.jvir.2018.08.023